How is vancomycin nephrotoxicity treated?

Current recommendations for the prevention or treatment of vancomycin-induced acute kidney injury are drug monitoring of plasma vancomycin levels using trough level and drug withdrawal. Oral prednisone and high-flux haemodialysis have led to the successful recovery of renal function in some biopsy-proven cases.

Is vancomycin really nephrotoxic?

Vancomycin is the drug of choice for methicillin‐resistant Staphylococcus aureus (MRSA)1 but has been associated with significant nephrotoxicity.

Is vancomycin-induced nephrotoxicity reversible?

Vancomycin-induced nephrotoxicity was reversible in the majority of cases, with short-term dialysis required only in 3% of nephrotoxic episodes. The collective literature indicates that an exposure-nephrotoxicity relationship for vancomycin exists.

Does vancomycin need renal adjustment?

An infection in the blood called bacteremia can develop during hemodialysis treatment and vancomycin is used to treat it. However, these patients cannot properly process the drug, and a dose adjustment needs to be made so it does not cause any further damage.

How long does vancomycin toxicity last?

In conclusion, early vancomycin therapeutic drug monitoring should be performed in order to avoid toxicities where, as seen in our patient, antibiotic exposure could last around 1 month after last dose administration.

What are the signs and symptoms of nephrotoxicity?

If severe enough, nephrotoxicity can show signs of other types of decreased kidney function, such as decreased urination, swelling from fluid retention and high blood pressure. In some patients, nephrotoxicity can also affect other body systems such as the liver or the skin and show signs in those areas as well.

What level of vancomycin is toxic?

It has been described that vancomycin trough plasma levels >20 μg/mL or AUC0–24 h >700 μg/mL*h are related to nephrotoxicity.

Is vancomycin safe in CKD?

Infectious Diseases Society of America guidelines recommend achieving vancomycin trough levels of 10 to 20 μg/mL. Usage of vancomycin in high dosages especially ≥ 4 g/d has led to an increase in the incidence of vancomycin-induced nephrotoxicity, particularly in patients with chronic kidney disease (CKD).

Can you give vancomycin in renal failure?

Vancomycin therapy is widely used in patients with decreased renal function, and serum levels of this agent must be closely monitored in such patients in order to avoid toxicity and subtherapeutic levels, in particular because emergence of resistance to glycopeptide antibiotics has been noted [12].

Can nephrotoxicity be reversed?

Drug-induced renal impairment is generally reversible, provided the nephrotoxicity is recognized early and the offending medication is discontinued.

How do you prevent nephrotoxicity?

Useful strategies to avoid nephrotoxicity from these drugs include using analgesics with less prostaglandin activity (acetaminophen, aspirin, sulindac, and nabumetone), correcting volume depletion before starting the drug, and monitoring renal function and vital signs when starting or increasing the dose of the drug.

What are the signs and symptoms of vancomycin toxicity?

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  • Black, tarry stools.
  • blood in the urine or stools.
  • continuing ringing or buzzing or other unexplained noise in the ears.
  • cough or hoarseness.
  • dizziness or lightheadedness.
  • feeling of fullness in the ears.
  • fever with or without chills.
  • general feeling of tiredness or weakness.